As healthcare systems across India mature, the local lab market is undergoing major changes. Labs are adopting new and innovative technologies at a faster pace than ever before, while policy shifts are impacting quality and access to laboratory services.

In this article, five leading Indian healthcare professionals share their views on these trends and what they mean for the evolution of the local lab market.

Accelerating Technology Adoption Curves

When a new diagnostic technology is launched in the United States or Europe, it used to take several years for it to reach the India market. Yet the scenario is rapidly changing, according to Dr Nita Munshi, Director Laboratory & Quality and Chairperson HICC at Ruby Hall Clinic, a multi-specialty hospital facility in Pune.

“India is identified as an emerging market with big opportunities and new solutions are being introduced in tandem across the world,” observes Munshi. One example is digital pathology, which came to India at roughly the same time that it was launched globally.

HiTech Diagnostics, a leading lab services company in Southern India, was one of the first in India to own a digital pathology system. “When we started in 1986 quality technology wasn’t available to everybody, but access to technology is seamless today,” says Dr SP Ganesan, HiTech Diagnostics’ CEO & Medical Director.

Ganesan argues that innovative business models and strong networks are key for deploying novel technologies effectively. After adopting digital pathology, for example, he immediately started working on tie-ups with international labs to support image analysis, as well as partnerships with local labs to extend this service across the country.

Empowered Patients Demand Better Quality

Another key trend is the rising sophistication of Indian healthcare consumers, who are growing increasingly engaged in care delivery processes.

“There is greater emphasis from patients to understand diagnostic procedures,” observes Mr Joy Chakraborty, Chief Operating Officer of P.D. Hinduja Hospital & Medical Research Centre, a multi-specialty tertiary care centre in Mumbai. “Today’s patients want to know the disease and recommended procedure in depth.”

Particularly at the top medical centres, patients are also showing greater concern about potential quality issues. “Patients have started questioning the accuracy of diagnostics,” says Dr Ram Narain, Executive Director of Kokilaben Dhirubhai Ambani Hospital (KDAH), another Mumbai-based tertiary care facility. “It’s important to create awareness about what quality in diagnostics services means.”

But despite these concerns, a minute fraction of labs in India have pursued accreditation with the National Accreditation Board for Testing and Calibration Laboratories (NABL). The Quality Council of India, which oversees the NABL, is currently working to strengthen the accreditation process [1].  

“NABL focuses a lot on the analytical phase but a significant number of errors take place in the pre-analytical phase,” remarks Dr Ganesan. “Audits need to be conducted in phlebotomy, sample collection and transportation to holistically improve lab quality.”

Policy Changes Raise Concerns About Price Capping

While middle-class and affluent patients in India’s major cities are increasingly gaining access to the latest diagnostic technologies and demanding high-quality healthcare services, much of the country’s poor and rural population still lacks access to basic care. Yet this is changing in the wake of the 2018 launch of Ayushman Bharat, a massive government programme that aims to provide health coverage and other benefits for up to 500 million people [2].

In parallel with the rollout of Ayushman Bharat, the Indian Council of Medical Research, a government-funded biomedical research organisation, is also developing a National Essential Diagnostics List (NEDL) in collaboration with the World Health Organization [3]. This list may help inform which diagnostics are offered under the Ayushman Bharat. It also raises concerns about price caps, notes G Narotham Reddy, President of Group Procurement and Corporate Development at Apollo Group of Hospitals, one of India’s largest integrated healthcare services providers.

Reddy believes that price caps are likely to discourage multi-specialty tertiary hospitals from participating in Ayushman Bharat, as their cost basis and quality standards may discourage them from meeting any government-issued price points.  

“A huge correction in prices cannot be done immediately,” says Reddy. “If the government policies operate at a level which enable operation at JCI and NABL standards, it would be an ideal scenario where the patient outcomes aren’t affected due to pricing control.”

Key Takeaways

+ India’s leading tertiary care centres are rapidly adopting new diagnostic technologies like digital pathology

+ Patients are increasingly demanding access to high-quality diagnostics services and getting engaged in their care decisions

+ A small fraction of Indian labs are accredited, but growing quality concerns may change this

+ The Ayushman Bharat initiative will improve access to healthcare services for up to 500 million people in India’s poor and rural areas, but may lead to price caps for some diagnostics

References:

[1] “Illegal path labs: India’s open secret,” Express Healthcare. (Published Jul 30, 2019; accessed Jan 20, 2020)

[2] “Ayushman Bharat: A big leap towards Universal Health Coverage in India,” KPMG Insights. (Published Dec 4, 2019; accessed Jan 20, 2020)

[3] “India gets its first national essential diagnostics list,” The Hindu. (Published Aug 16, 2019; accessed Jan 20, 2020)